Doctors today can tell a great deal about a child from a very early age. In the womb, for instance, tests can reveal risk for Down syndrome and a range of other conditions. Within a baby’s first year or two, health professionals can spot signs of significant developmental disabilities, possibly even autism. And some now believe they can tell if preschoolers are showing risk factors for becoming a psychopath, someone potentially capable of committing bone-chilling crimes without an ounce of guilt or remorse.

Some mental health professionals believe that Columbine killer Eric Harris showed signs of being what’s termed a fledgling or budding psychopath. Harris was one of the two teenage killers who 10 years ago today went on a school-shooting spree that left 12 students and a teacher dead and about two dozen more injured before they both committed suicide. The term psychopath, however, is generally reserved for adults, whose personalities are more firmly fixed. Harris had turned 18 only days before the massacre.

One psychiatrist linking Harris with possible psychopathy is Dr. Frank Ochberg, a psychiatry professor at Michigan State University who was involved in an FBI school-shooting symposium held shortly after Columbine and who also made trips to Littleton, Colo., for more than a year after the incident “to help Columbine heal,” he says. Ochberg believes that the two killers, Harris and 17-year-old Dylan Klebold, were a “deadly duo” who probably wouldn’t have done what they did without the other. Whereas Klebold was depressive and hot-headed, Ochberg says, Harris was “cool, cold and calculating,” glib, showed little reaction to discipline and was easily able “to read people” and ingratiate himself to others.

“I do believe Harris was well on his way to being what we would call a psychopath,” he says. “He showed very little conscience.”

Lack of conscience is the hallmark of psychopathy, which is estimated to occur in about 1 percent of the adult population, says psychopathy expert Robert Hare, a professor emeritus of psychology at the University of British Columbia and author of “Without Conscience: The Disturbing World of the Psychopaths Among Us.” Unlike psychosis, in which a person is out of touch with reality and experiencing delusions or hallucinations, for example, psychopaths know what they are doing. They just don’t care — and can’t really comprehend — how their actions hurt others. Psychopaths lack empathy, guilt and remorse, explains Hare.

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But it’s only a small minority of psychopaths — albeit a very dangerous, mostly male, minority — who become mass murderers, serial killers and rapists, and torturers. And, some experts say, if a budding psychopath can be identified young enough, perhaps it might be possible to change what otherwise might be their destiny.

The road to psychopathy
Some mental health professionals say they can recognize early markers in kids as young as toddlers for what may later develop into psychopathy, but don’t like to diagnose children as psychopaths. It’s a stigmatizing label that may not hold true when they are adults since children have a great capacity to change.

Experts also emphasize that not all children who appear to be at risk for psychopathy go on to become psychopathic adults. But they can look at psychopathic adults and see similar themes in their early childhoods.

Adult psychopaths commonly have a long history of significant behavior problems in youth and juvenile delinquency (although most delinquents will not become psychopaths). Studies show that a significant portion of children who show psychopathic traits — often referred to among researchers as “callous-unemotional (CU) traits,” which include not being concerned about others’ feelings and not feeling bad or guilty — as early as the preschool years have the same traits when they are teens. And adolescence is a time when they are more likely than other kids to exhibit extreme behavior problems, aggression and delinquency. These teens with significant CU traits are then more likely to become psychopathic adults. But, they say, it’s also possible for some kids with CU traits, particularly the youngest ones who have the greatest capacity to change, to simply grow out of them.

CU traits are most reliably assessed starting at age 4, but even 2-year-olds can exhibit signs that they are lacking “early empathy,” says Paul Frick, chair of the department of psychology at the University of New Orleans who studies youth behavior problems. For instance, he says, a typical toddler may hit another child, watch that child cry and then cry himself in response because he feels bad. But a toddler who lacks empathy will be unfazed by the other child’s reaction or efforts at parental discipline.

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Some mental-health professionals believe that Columbine shooter Eric Harris, shown here in a photo from his high school yearbook, showed signs of being what’s termed a fledgling or budding psychopath.

“They don’t respond to distress in others and to punishment the same way as other kids,” Frick says.

Another trouble sign is a child who’s extremely aggressive, he says. Of course, many young children are aggressive at times, and that’s to be expected, but routinely being very aggressive is not. Red flags include frequent bullying and fighting, vandalizing, fire-setting and hurting animals.

A gene for psychopathy?So what’s at the root of this antisocial behavior at such a young age? There are various theories about what causes CU traits and later psychopathy, but there are no definitive answers. Both nature and nurture — including life experiences dating back to infancy — have been implicated. But experts say there is no simple answer that explains all cases.

“The evidence has indicated it’s not neither nor,” says Hare, the Canadian psychopathy expert. “The question is: To what extent can one trump the other? And we don’t know.”

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Some of the strongest evidence for a genetic basis comes from a 2005 study published in the Journal of Child Psychology and Psychiatry that pointed to a strong inherited component for CU traits among 7-year-old twins from the United Kingdom. The study, which involved 3,687 twin pairs who were assessed by their teachers, found that extreme CU traits were more strongly linked among same-sex identical twins than fraternal twins, evidence of a greater genetic basis. The study also found a strong genetic component for extreme antisocial behavior — fighting, bullying, lying, cheating and stealing — among children with high CU traits. But extreme antisocial behavior among children without CU traits appeared to have a stronger environmental influence.

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Experts say they see this played out to some extent among adults in prisons where criminals, most of whom are “sociopaths” who, unlike psychopaths, have a conscience, often grew up in harsh environments characterized by factors such as abuse, deprivation or gang violence that seem to play significant roles in shaping their attitudes and influencing their behaviors. Psychopaths might also have had unhappy home lives, but in what seems so inexplicable, they can come from stable homes, too, suggesting more of a genetic influence in these latter cases.

Like other troubled youth, those with CU traits may be given the diagnosis of “conduct disorder” but they are more likely to become delinquents in adolescence and to become adults often diagnosed officially with the broader “antisocial personality disorder.” The psychiatric field’s Diagnostic and Statistical Manual of Mental Disorders does not include a separate entry for psychopathy, though Hare is lobbying for one in the next edition.

“The majority of criminals would meet the criteria for antisocial personality disorder but only 10 to 15 percent meet the criteria for psychopathy,” says Hare, who developed widely used psychopathy checklists for determining whether adults and juveniles as young as age 12 show psychopathic tendencies. Gang members, for instance, who kill or steal for their group might be viewed as people with antisocial personality disorder, or sociopaths. But unlike psychopaths, they may truly love — and would never hurt — their own families, and they also may feel guilt or remorse about their crimes.

Though investigators are searching for psychopathy genes, Hare believes there will never be just one gene but more likely a cluster of genes that somehow influence such traits as impulsivity, fear and empathy. Even if such genes are found, experts say, it doesn’t mean there is such a thing as a natural-born killer. At the same time, most experts agree that genetic factors likely come into play because most people who have deprived, abusive or otherwise rotten childhoods don’t grow up to become cold-blooded murderers.

“You’re not born a psychopath but the foundation is there,” Hare says. “We’re all born with temperaments that can be shaped by the environment.”

Furthermore, most psychopaths aren’t violent offenders. Those raised in deprived environments may grow up to be street criminals, for instance, whereas those raised in privileged homes may become corporate criminals, says Hare. Others won’t be criminals at all.

Psychopaths may be influenced by a bad home environment but they also can come from seemingly happy, loving homes, where “no matter how much love mommy gives, the child just doesn’t connect,” says Hare.

Brain differences
Ochberg believes that genetics plays a strong role in the development of psychopathy, and that environmental influences are much less important. “I believe the building blocks of psychopathy are largely inherited,” he says, “and by 5 or 6 you either put together a normal conscience, a superego, or you don’t.”

Harris appears to be a case in point, says Ochberg. “I don’t think early life exposure contributed to his lack of conscience,” he says, nothing that Harris had a “conventionally good older brother.”

“My opinion is the die was probably cast by age 6 for psychopathy through no fault of his parents,” Ochberg says. “They seem, from what I was able to learn, perfectly capable of raising a normal child.”

In addition to searching for genetic markers, researchers also are peering into the brains of psychopaths, using imaging techniques to look for physical clues of the condition. Research has suggested, for instance, that psychopaths may have reduced activity in areas of the brain, such as the amygdala, that play key roles in emotion. Another theory is that psychopathy is related to a defect in the “paralimbic system,” which comprises the amygdala and several other regions of the brain. This latter theory is being investigated in adult and juvenile offenders who’ve undergone MRI scans.

Researchers also know that kids who were exposed to toxins in the womb or experienced difficult births that deprived them of oxygen or involved head trauma are at greater risk of behavior problems. A possible role of these experiences in the development of psychopathy is unclear.

Averting destiny
Adult psychopathy is generally viewed as difficult or even impossible to treat, particularly for repeat violent offenders. Medications and talk therapy don’t work, according to Hare and others. Inmates may very convincingly say what they think counselors want to hear because it serves a purpose to them, such as getting paroled. And psychopaths outside of the prison system may never enter treatment. “No self-respecting psychopath is going to seek therapy in the real world because they don’t think there’s anything wrong with them,” says Hare.

But because children are more malleable, experts hope they can one day prevent kids with CU traits from going down a road of destruction. Can they teach these kids empathy? Can they help them develop something of a conscience?

If not, they at least want to work with the kids and their families to make sure the kids have good parenting and to teach the children ways to better conform to society’s norms to reduce their risk of becoming juvenile delinquents, school shooters and adults whose crime sprees lead to life imprisonment.

While it might not be possible to help people develop a conscience, perhaps they can be convinced that it’s in their best interest to act as if they do. While psychopaths and kids with CU traits know society’s rules, they don’t care to follow them. And they’re impulsive, so they don’t necessarily think through the consequences of their actions. They just act, so this approach has to focus on how they directly benefit, because they really don’t care about how their actions impact others, explains Hare. So, for instance, it would likely be futile to try to get them to change their behavior by explaining just how much they hurt others. They can’t relate.

“The idea is to get them early and to try to modify their behavioral tendencies,” says Hare.

Motivating budding psychopaths through praiseFrick says some of the best evidence for helping kids with CU traits comes from an Australian study of boys ages 4 to 8 with conduct problems. Those with CU traits did not respond to the common discipline strategy of time-outs but they did show a response to a parenting strategy in which they were rewarded — praised — for good, “prosocial” behavior. Frick says the study, published in 2005 in the Journal of Consulting and Clinical Psychology, makes sense considering that people with psychopathic tendencies tend to be reward-driven and largely insensitive to punishment.

Experts agree that much more research is needed to understand why kids act out. And it’s misguided to lump them all into a single category of troubled youth and attempt to treat their problems in the same way. As Columbine showed, two kids who carry out the same act can be very different people at their core.

And while school shooters tend to be teen-agers, the Jonesboro, Ark., massacre in March 1998 involved an 11-year-old boy. He and another boy, just 13, shot at their middle school from the adjacent woods, killing five and injuring 10.

“There really is no profile of the school shooter,” says psychologist Mary Ellen O’Toole, who recently retired as a special agent with the FBI’s behavioral analysis unit. After Columbine, O’Toole authored an FBI report titled “The School Shooter: A Threat Assessment Perspective.”

Having studied many school shootings, O’Toole believes at least some of them could have been prevented with the right help. “If you could get some of these kids over some kind of a hump — get them through high school and into college — I don’t think some of these shootings would have occurred,” she says.

O’Toole also doesn’t think that young kids who exhibit callous-unemotional traits are doomed from the start. “Are people hopeless at 4 or 5 years of age, so that any degree of intervention is hopeless? I don’t believe that,” she says.

“To say that it’s hopeless, I think, is close-minded,” says O’Toole.

Jacqueline Stenson is a freelance writer in Los Angeles. A former senior health producer for msnbc.com, her work also has appeared in publications including the Los Angeles Times, Health, Family Circle, Fit Pregnancy, Shape and Reuters Health.